Types & Stages

Kidney Cancer: Types & Stages

Using the TNM system, the “T” plus a letter or number (0 to 4) is used to describe the size and location of the tumor. Some stages are also divided into smaller groups that help describe the tumor in even more detail. This helps the doctor develop the best treatment plan for each patient. If there is more than one tumor, the lowercase letter “m” (multiple) is added to the “T” stage category. Specific tumor stage information for kidney cancer is listed below.

TX:The primary tumor cannot be evaluated

T1:The tumor is found only in the kidney and is 7 centimeters (cm) or smaller at its largest area. There has been much discussion among doctors about whether this classification should only include a tumor 5 cm or smaller.

  • T1a:The tumor is found only in the kidney and is 4 cm or smaller at its largest area.
  • T1b:The tumor is found only in the kidney and is between 4 cm and 7 cm at its largest area.

T2:The tumor is found only in the kidney and is larger than 7 cm at its largest area.

  • T2a:The tumor is only in the kidney and is more than 7 cm but not more than 10 cm at its largest area.
  •  T2b:The tumor is only in the kidney and is more than 10 cm at its largest area.

T3:The tumor has grown into major veins within the kidney or perinephric tissue, which is the connective, fatty tissue around the kidneys. However, it has not grown into the adrenal gland on the same side of the body as the tumor. The adrenal glands are located on top of each kidney and produce hormones and adrenaline to help control heart rate, blood pressure, and other body functions. In addition, the tumor has not spread beyond Gerota’s fascia, an envelope of tissue that surrounds the kidney.

  • T3a:The tumor has spread to the large vein leading out of the kidney, called the renal vein, or the muscular branches of the renal vein, or it has spread to the fat surrounding the kidney and/or the fat inside the kidney. The tumor has not grown beyond Gerota’s fascia.
  • T3b:The tumor has grown into the large vein that drains into the heart, called the inferior vena cava, below the diaphragm, the muscle under the lungs that helps breathing.
  •  T3c:The tumor has spread to the vena cava above the diaphragm and into the right atrium of the heart or to the walls of the vena cava.

T4:The tumor has spread to areas beyond Gerota’s fascia and extends into the adrenal gland on the same side of the body as the tumor. The “N” in the TNM staging system stands for lymph nodes, the tiny, bean­shaped organs that help fight infection. Lymph nodes near the kidneys are called regional lymph nodes. Lymph nodes in other parts of the body are called distant lymph nodes.

NX:The regional lymph nodes cannot be evaluated.

N0:The cancer has not spread to the regional lymph nodes

N1:The cancer has spread to regional lymph nodes.

The “M” in the TNM system indicates whether the cancer has spread to other parts of the body, called distant metastasis. Common areas where kidney cancer may spread include the bones, liver, lungs, brain, and distant lymph nodes.

M0:The disease has not metastasized.

M1:The cancer has spread to other parts of the body beyond the kidney area. Doctors assign the stage of the cancer by combining the T, N, and M classifications.

Stage I:The tumor is 7 cm or smaller and is only located in the kidney. It has not spread to the lymph nodes or distant organs (T1, N0, M0).

Stage II:The tumor is larger than 7 cm and is only located in the kidney. It has not spread to the lymph nodes or distant organs (T2, N0, M0).

Stage III:Either of these conditions:

  •  A tumor of any size is located only in the kidney. It has spread to the regional lymph nodes but not to other parts of the body (T1, T2; N1; M0).
  • The tumor has grown into major veins or perinephric tissue and may or may not have spread to regional lymph nodes. It has not spread to other parts of the body (T3; any N; M0).

Stage IV:Either of these conditions:

  • The tumor has spread to areas beyond Gerota’s fascia and extends into the adrenal gland on the same side of the body as the tumor, possibly to lymph nodes, but not to other parts of the body (T4; any N; M0).
  • The tumor has spread to any other organ, such as the lungs, bones, or the brain (any T, any N, M1).